Read this important information before taking:

For more information to help keep you safe, visit: www.consumermedsafety.org.

When Your Doctor Prescribes Oral Methotrexate Tell your doctor about all your diseases and conditions.Methotrexate may not be right for you if

you have any of the following: a blood or bone marrow disorder (e.g., low white blood cell or platelet count,anemia); kidney or liver disease; stomach ulcer; ulcerative colitis; AIDS; a drinking problem; a weak immunesystem; or if you are pregnant or plan to become pregnant.

Tell the doctor what else you take. Certain medicines increase the risk of bad side effects when takenwith methotrexate. Provide the doctor with a list of all the prescription, over-the-counter, and herbal medicines,vitamins, and other dietary supplements you take. While taking methotrexate, tell your doctor if you start orstop any medicines, herbals, or dietary supplements. Common over-the-counter medicines, herbal medicines,and vitamins to avoid can be found on the other side of this page in the Fast Facts table.

Know why you take oral methotrexate and how to take it. To treat conditions like psoriasis andrheumatoid arthritis, methotrexate is taken in a single dose ONCE A WEEK. Or, the weekly dose may be dividedinto three smaller doses that are taken 12 hours apart. The medicine is NEVER taken daily to treat conditionsother than cancer. Check that you understand by telling the doctor why you are taking methotrexate, how oftenyou will take it, what strength pills you will take, and how many pills you will take each time.

Look for the reason. Ask your doctor to put the reason for your medicine on the prescription. Small dosesused to treat conditions like psoriasis and rheumatoid arthritis are taken just once a week or in three smallerdoses taken 12 hours apart. Larger doses used to treat cancer may be taken more often. Your pharmacist canmake sure your dose and directions for taking the medicine are correct if your condition is on the prescription.

When Filling Your Prescription for Oral MethotrexateChoose a day. Choose a day of the week that you will take your medicine and ask your pharmacist to include

that in the instructions on the label. Avoid “Monday,” which has been misread as “Morning.” This mistake has ledpeople to take a dose each “Morning” instead of each “Monday.”

Ask for education. Ask your pharmacist to go over the directions for taking the medicine.

When Taking Oral Methotrexate Take exactly as directed. Do NOT take methotrexate every day or take extra doses to relieve your symptoms.

Symptom relief begins in 3 to 6 weeks after starting the medicine. Improvement is gradual for the first few months.

Tell your healthcare providers. Tell your doctors, dentists, and pharmacists that you are taking methotrexate.

Avoid sunlight. Methotrexate can cause severe sunburn. If you are in the sun, use a sunscreen on your skinand wear sunglasses and a hat.

When You Should Call Your Doctor Call immediately if you have severe diarrhea or black stools (poop); sores in your mouth, nose, or throat; a rash

or red, peeling, blistered skin; fever or chills; trouble breathing; a racing heartbeat; bleeding; very bad dizziness orweakness; confusion; persistent stomach or back pain; or changes in how often you urinate. If you can’t reach yourdoctor, get medical treatment in an emergency room or urgent care center.

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Oral Methotrexate (to treat conditionsother than cancer)

Deadly errors have happened when methotrexate was taken daily instead of just once a week.To treat conditions besides cancer, this medicine should be taken weekly, NOT daily. Weeklydoses are taken as a single dose or divided into three smaller doses taken 12 hours apart.

STOP

DO NOT TAKE THIS MEDICINE EVERY DAY!

Take extra care! Oral methotrexate is a high-alert medicine. This means that oral methotrexate has been proven to be safe and effective, but it can

cause serious harm, including death, if not taken exactly as directed—just Once A Week.

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This information does not replace the need to follow your doctor’s instructions. Read the drug information leaflet provided with your prescription.

Oral MethotrexateOnce a WEEK is the Only Way!

ethotrexate is acancer medicine.

However, it is also used totreat other conditions likerheumatoid arthritis andpsoriasis. It works well forthese conditions if you takethe medicine just once aWEEK and in smaller doses.

Most medicines are takendaily, but not methotrexate. If

you take methotrexate everyday by accident, you could beharmed. Sadly, some peoplehave even died when takingmethotrexate daily forconditions other thancancer.

In one case, an olderman with arthritismistakenly took onetablet each morning,

but the directions said totake one tablet eachMonday. In another case, theprescription label said to

take the medicineevery 12 hours forjust three doses. Buta woman took themedicine every 12hours for 6 days in arow. Another mantook many extra

doses to help relieve arthritispain, something that shouldnever be done.

Serious harm, even death,could occur if you takemethotrexate daily forconditions other than cancer.

Read the Top 10 List of SafetyTips on the other side of thishandout to help avoid mistakes.

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Read this important story!

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Topics Fast Facts

Generic name methotrexate (pronounced meth-o-TREKS-ate)

Common brand names Trexall (tablets), Xatmep (oral liquid) (generic available for tablets)

Common uses (to treat conditionsother than cancer)

Rheumatoid arthritis, juvenile arthritis, psoriasis, multiple sclerosis, lupus, difficult-to-treat asthma,inflammatory bowel disease (Crohn’s disease), other inflammatory diseases

Usual dose Most common strength of pills is 2.5 mgUsual dose is 5 mg to 30 mg weekly (higher doses are used only if treating cancer)Weekly doses are taken as a single dose or divided into three smaller doses taken 12 hours apart(no more than three doses should be taken 12 hours apart each week)If you forget to take a dose, call your doctor for instructions

Special instructions and precautions

Your doctor may prescribe folic acid with methotrexate; your doctor may instruct you to skip thefolic acid on the day you take methotrexateAvoid drinking alcohol while taking this medicineThis medicine may affect fertility in both men and women

Safety during pregnancy/breastfeeding

Methotrexate is known to cause birth defects in the children of both men and women who take itWomen should not take methotrexate during pregnancy; to be safe, talk to your doctor about howlong to wait after treatment to become pregnant (usually 1 to 3 months) Men should wait at least 3 months after stopping treatment before getting their partner pregnantDo not take methotrexate while breastfeeding, as it can harm your baby

Storage Store at room temperature and protect from lightKeep the lid of the medicine tightly closedKeep oral methotrexate and all medicines out of the reach of children

Side effects Minimal side effects (e.g., nausea, vomiting, drowsiness) occur with low doses (30 mg or less eachweek)A very bad skin reaction (Stevens-Johnson syndrome) may happen; get medical help right away if youdevelop red, peeling, blistered skin; a skin rash; or sores in your mouth, nose, or throat

Over-the-counter medicines,herbals, or vitamins that should NOTbe taken with methotrexate UNLESSprescribed by your doctor

Vitamins that contain folic acid or echinacea Aspirin and aspirin-containing products; ask your doctor before starting, continuing, or stoppinglow dose aspirin (81 mg daily)Check with your doctor if you take medicines for acid reflux or heartburn (e.g., Prevacid, Prilosec,Nexium)Check with your doctor if nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin,Advil) and naproxen (Aleve) can be taken safely with methotrexate

Prescription medicines that shouldNOT be taken with methotrexate

Check with your doctor; some medicines that may be a problem include: vaccines, acitretin,cyclosporine, foscarnet, sulfonamides, tacrolimus, pimecrolimus, clozapineDo not take methotrexate with antibiotics that contain trimethoprim and sulfa (e.g., Bactrim,Sulfatrim); your doctor may tell you to skip your dose of methotrexate that week

Special tests your doctor mayprescribe

If you can get pregnant, a pregnancy test will be done to be sure you are not pregnant beforestarting methotrexateYour doctor may check your kidney and liver function and make sure your body is making enoughblood cells with a blood test every 1 to 3 months